Rationing is a logical outcome, and any changes must be incremental

This post continues my Ten Principles of Affordable Healthcare Reform.

Health care changes should be made in small increments, easily understood by the People.

Any changes that are made should be made in small increments and they should be cost effective and easily accepted by the public. It is clear at this juncture that we cannot afford the breadth and the scope of “reform” that is being currently proposed; to do so would constitute nothing less than fiscal nymphomania leading to financial suicide. We would not be pushing grandma over the cliff; we would be pushing ourselves along with her.

If I have learned anything in the last 35 years addressing these questions, it is that any change must be gradual and universally acceptable by the constituency most affected by it. What I cited above is an example. Such small steps that would be universally accepted would include the elimination of geographic boundaries with respect to the provision of healthcare insurance claims and ratings. The elimination of the “preexisting” clause is yet an example of another small step that could be accomplished. The issue of insurance portability from job to job, and state to state is another that could be readily accepted. Biting off more than one can politically chew not only leads to constituency indigestion, but can, in a further political sense lead to choking to death, particularly in severe economic times when the populace has little if any trust in their elected representation. The problem is it would be We the People doing the choking, and not those who we elected.

Rationing is a logical outcome in any system with limited resources and high demand.

We must accept that rationing is a logical outcome of any system with limited resources and high demand. To grandstand this issue is not only an insult to your intelligence, it is out and out balderdash, pure rubbish!

Any scarce resource that must be used over an extended period by a large number of people logically must be rationed. The terms, definitions and nature of the rationing of public money should be determined by those charged by that same public to ascertain, adapt and legislate outcomes that are in the best overall interests of those they serve and whose money they distribute. These decisions should not be in the hands of political appointees, hand picked by the Administration as is the case in the current Law (Independent Payment Advisory Board or IPAB). To whom would we appeal? Will the bureaucrat on the other end of the line really care? What further cuts will this arbitrary board make in the future as our abilities to fuel this monster diminish over time?

At this time, The PPACA aka Obamacare, which is now the law, calls for all healthcare expenditures to be monitored by the IPAB, including those of commercial carriers. That said, let’s turn to Medicare and talk about rationing and Death Committees.

Right now, Medicare turns down 6.85% of all its claims, more than double that of Cigna and Humana (but interestingly, almost the same as Aetna). Is this not rationing? In the last years of life, how many of you have a Do Not Resuscitate or DNR in your Living Will? How many of you want to pass peacefully, and not squander what you have saved to pass on to your grandchildren and children? So, if you think it not prudent to spend your own money, where is the prudence in spending the public’s money? We need to understand that death is a part of life and accept that, and like anything else, it is something for which we must plan. When I hear the gibberish about Death Committees all I want to do is just say Put a sock in it!

Clearly, difficult choices will have to be made in the future. Our choice right now is whether healthcare should be rationed by free people making their own economic decisions and calculations or by a bureaucracy run by a non-elected, not Congressionally approved IPAB with no Congressional oversight who can run amuck any time they choose. If I am making my own decisions, as any free individual should, then I am likely to utilize only what I value above price, using funds I have earned, or in the case of charity, have given voluntarily. This self-imposed rationing is done freely and of my own will with my own property and my own discretion and not at the political whims of others for whatever reasons they choose. Simply stated, I believe that the individual at the end stages of life and his/her family, and not the government must do the rationing, for it is in the last two years of life that Medicare spends 27.4% of all its outlays for the elderly. I also believe that sometimes the physician must just say “No!” What a street-smart colleague of mine has said is that we must no longer be presented with a smorgasbord of care. The price is too high and the value of becoming overstuffed is no longer fiscally healthy or sustainable.

Mitchell Brooks  is an orthopedic surgeon and the host of Health of the Nation on Talk Radio 570 KLIF in Dallas, Texas.  He blogs at Health of the Nation.

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  • Anonymous

    “Never tell a man when he is going to die. He may live to p**s on your grave.”

  • http://twitter.com/amhill michael hill

     “I believe that the individual at the end stages of life and his/her family”Isn’t that exactly what we have now?

  • Anonymous

    I don’t know a single person who wants to spend the last moments of life being tortured in a hospital.  My greatest fear is not being denied that last chance medical treatment but to be tortured by greedy doctors who want to use my death to make a profit.  My family has strict instructions on what to do for end of life care because I know that doctors ignore the DNR like they did for my grandfather.  Once the quality of my life reaches a certain point, I am going to refuse medical care.

    • Anonymous

      You make a great point and one that is worth sharing with everyone, save the “greedy doctor” aspect.

      The real issue is that death is a part of life and that the decision of when and how to die should be a discussion had long before any chronic illness enters its endstage.

      The net result is that the patient dies with dignity, the family has control of the situation, funds that have been saved to pass on to children and grandchildren are not squandered and the physician has a clear direction with clear orders. Add to that the dignity of dying at home surrounded by family and loved ones, and you have a paradigm shift that creates a successful outcome for all the stakeholders in the healthcare equation.

      Mitchell Brooks, M.D.
      http://www.hotnationtalk.com

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    “If I am making my own decisions, as any free individual should, then I
    am likely to utilize only what I value above price, using funds I have earned, or in the case of charity, have given voluntarily. This self-imposed rationing is done freely and of my own will with my own property and my own discretion and not at the political whims of others for whatever reasons they choose.”

    What exactly does this mean? Dismantling Medicare? Everybody is on their own? I thought this was usually termed “rationing based on ability to pay”. I don’t see what this has to do with self-imposed anything, or freedom for that matter.

    • Anonymous

      It has to do with the freedom to choose for oneself. If I choose to be charitable then I will be. I have no choice with respect to paying taxes which, in and of itself is a charitable contribution for the country. That I choose to be charitable in my community is a reflection of my ethic and my sense of duty to my fellow man. It is not for government to impose such charity upon me! Thie imposition is met every April 15th.

      The “everyone is on their own” is not the logical conclusion to this scenario. Why is it that people always go to the extreme to make a counter point, and assume that the point to which they respond is radical?

      Rationing will occur even more and does occur currently in all types of coverage from commercial to state sponsored. This is the rationing of money. What will follow is the rationing of time expressing itself in increased waits; that is, the rationing of time.

      The truly needy deserve support, but for those who are chronic abusers of “the system”, there needs to be a “pay as you play” plan. You need to work and earn what you receive. This is a basic societal pillar that has been steadily eroding away since The Great Society in the vortex of what we call “fairness”. It has morphed into the cancer called “Entitlement”. Well, as I used to tell my child, life is not fair, period.

      There is only a fixed amount of funding available for healthcare. Given this fact, those who are chronic takers from the system, but who are truly not needy, and contribute nothing in return are, de facto, stealing from others who ante up to the public pot labeled “healthcare funding”. 

      When money goes to them to treat a disorder of their own making and subject to their life-style decisions, their personal choice, such as diabetes, obesity or heart disease, they are stealing healthcare funds from your children and your family, from the child with a long term disability or from the wife and mother awaiting a heart transplant. There is less money in the communal pot for this latter group of people. Is that right? Is that fair? 

      What say you then to these people if it is your daughter who requires, say, a liver transplant but the global funding available for it has been drained by this former cohort of non-taxpayers? What happens when the “shoe is on the other foot”. “That’s far-fetched” you say? Tell that to the Canadians and Brits who come to the United States seeking organ transplantation or a bypass procedure or a total hip arthroplasty because the waiting times in their own countries are so absurdly long!

      Life is not fair. If you are of able body you must earn what you reap. Destroy this basic premise of societal behavior and order, and you will surely destroy the society in which you impose this absurdity… in any form it takes. Nero fiddles, Rome burns!

      Mitchell Brooks
      http://www.hotnationtalk.com

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